Therapy for Patients With Sleep/Wake Disorders

From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.

This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.

Learning Objectives

Students will:

· Synthesize concepts related to the psychopharmacologic treatment of patients

· Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders

· Synthesize knowledge of providing care to patients presenting for sleep/wake disorders

· Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders

  

Learning Resources

Required Readings (click to expand/reduce)

https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.DSM5&site=eds-live&scope=site

https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2422903356%3Faccountid%3D14872

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1720529955%3Faccountid%3D14872

Medication Resources (click to expand/reduce)

https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

   

· alprazolam

· amitriptyline

· amoxapine

· amphetamine

· desipramine

· diazepam

· doxepin

· eszopiclone

· flunitrazepam

· flurazepam

· hydroxyzine

·  imipramine

· lemborexant

· lorazepam

· melatonin

· methylphenedate

· modafinil

· armodafinil

· carnitine

· clomipramine

· clonazepam

· nortriptyline

· pitolisant

· ramelteon

· sodium oxybate

· solriamfetol

· SSRI’s

· temazepam

· trazodone

· triazolam

· trimipramine

· wellbutrin

· zaleplon

· zolpidem

Required Media (click to expand/reduce)

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_11/index.html

Required Media (click to expand/reduce

  

Assignment 1: Short Answer Assessment

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

Photo Credit: Getty Images/Collection Mix: Sub

To Prepare

· Review the Learning Resources for this week.

· Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.

· Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?

2. List 4 predictors of late onset generalized anxiety disorder.

3. List 4 potential neurobiology causes of psychotic major depression.

4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.

Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018

To prepare for this Assignment:

· Review this week’s Learning Resources, including the Medication Resources indicated for this week.

· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

NOTE

FOR THIS ASSIGNMENT, YOU WILL WORK WITH :

DECISION 1: TRAZADONE 50-100 MG DAILY AT BEDTIME.

DECISION 2: DECREASE TRAZADONE TO 25 MG AT BEDTIME

DECISION 3 : CONTINUE TRAZADONE AND ENCOURAGE SLEEP HYGIENE.

 

For your third brief essay, your focus will be on revising and editing your first essay. Overall, you will be expanding your first essay, adding 1-2 pages in length to the 3 you have already written. You should begin by proofreading your paper lightly, and deciding which areas could be expanded. Consider: do you want to add all-new paragraphs, or do you want to expand existing paragraphs, or do a combination of both?

The second part of this assignment is to edit and revise your first essay based on all that we have studied this semester.

Consider some of the following:

• Are there weak points in your argument?
• Did you find any evidence of biases, complexes, or fallacies?
• Or, did you seem to avoid those altogether?
• Is there a good balance between logos, pathos, and ethos?
• Were your in-text citations accurate, or do those need fixing?
• Did your works cited page match MLA style, or did it need correction?
• Did you happen to use a weak source that you now decide is unreliable?
• Did you use proper paragraph structure, with topic and conclusion sentences?
• Overall, did you need to fix your grammar, punctuation, or spelling?
• Considering all of the handouts and guides we have used, what other corrections need to be made?
• Were fixes required to structure and style issues, such as your headers, heading, margin widths, indentations, and related requirements?

Assignment Details: Your final product should be a clean, revised 4-5 page-long essay.

 Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. 

Discussion

Discuss the questions that would be important to include when interviewing a patient with this issue.

When interviewing an adolescent, some prevention and counseling may include questions about:

• Home
• Education / Employment
• Eating
• Activities
• Drugs
• Sexuality
• Suicide / Depression
• Safety / Violence

Questions I would ask in regard to her vaginal bleeding would include:

When did your last period begin?

How long do your periods last?

What other symptoms do you have with your period? (abdominal pain, headache, bloating, etc.) Is your bleeding irregular in amount or duration?

Do you have bleeding between your menstrual cycles?

Are your breasts tender?

Are you sexually active?

Is it possible that you are pregnant?

Do you have any pelvic pain?

How severe (1-10 scale) is your pelvic pain?

Have you had pelvic inflammatory disease?

Do you have pain with intercourse?

Have you had sex that was painful or rough, or been forced to have sex?

Are you having, or have you had unprotected sex?

Have you had any sexually transmitted disease?

 Describe the clinical findings that may be present in a patient with this issue.

Being that this patient’s vaginal bleeding is due to a spontaneous abortion, some of the clinical findings may include vaginal bleeding, abdominal pain, and passage of tissue (Alves, 2020).

 Are there any diagnostic studies that should be ordered on this patient? Why?

Along with beta-hCG measurement and ultrasound, a HGB and HCT should be obtained to rule out acute blood loss anemia.  Since spontaneous abortion can be precipitated by infection, wet mount examination and screening for gonorrhea and chlamydia should be considered (Alves, 2020).

 List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Differential Diagnosis

• Ectopic      pregnancy– A      pregnancy in which the fertilized egg implants outside the uterus.  Symptoms include      pelvic pain and vaginal bleeding.
• Molar      pregnancy- A noncancerous tumor that develops in the      uterus as a result of a nonviable pregnancy. The pregnancy may seem      normal at first, but when symptoms develop they include dark brown to      bright red vaginal bleeding during the first trimester, along with severe      nausea and vomiting (Al-Talib, 2016).
• Viable      pregnancy with implantation bleeding- When the fertilized egg attaches to      the uterine wall, it may cause bleeding that can last 2-3 days

Primary Diagnosis

• Spontaneous      Abortion- Spontaneous      abortion is the loss of pregnancy naturally before 20 weeks of gestation      (Alves, 2020).

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

The conventionally accepted regimen for medical management consists of misoprostol 800mcg vaginally, with a repeated dose if needed anytime from 3hrs to 7 days after the first dose.  Premedication with mifepristone 200mg PO 24hrs before the first dose of misoprostol may result in a higher success rate.  Surgical management consists of D&C as needed (Alves, 2020).  Follow up as directed my healthcare professional.

Reference

Al-Talib, A. (2016).  Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a tertiary care hospital in Dammam, Saudi Arabia.  Journal of Family & Community Medicine 23(3), p. 161-165.  doi: 10.4103/2230-8229.189129

Alves, C. (2020).  Spontaneous abortion.  StatPearls.  Retrieved from https://www.statpearls.com/articlelibrary/viewarticle/29399

 

Organizational Leadership Vision: Due 3/15

For this final reflection paper, you will be identifying five concepts from the course that you have found useful to you as you imagine yourself in a future leadership/management or ownership role in an organization. You can use any material from the entire course for this assignment that you have not written about already.  A concept would be something similar to the items you have been writing about all semester for your organizational behavior and leadership papers.

Introduction

One sentence describing the assignment.

The Vision [125-150 words]

Please project yourself in a future role in your career in which you imagine that you have responsibility for the success of a group of employees. Start your paper off with an introductory paragraph that sets the context for this future role, by giving some information about the type of company or department that you would picture yourself leading in the future. Identify the time setting, i.e. five from now, ten years from now, etc. The more clearly you can paint a picture of this future role, the more effective the rest of your paper will be. Include some idea about the type of work that most of your employees will be doing, at least the major “job families” in the company.

Concept Description [250-300 words]

For this section you should first explain your approach and give an overview to the concepts you are choosing.  This section will bridge the gap between the role that you defined above and the concepts you will be applying.  Then identify the concepts that we have studied throughout the course, that you imagine would be useful for you to use as a leader in order to establish a strong organizational experience for your employees. Identify each of the five concepts that are most important and provide a very short definition (one or two sentences) of that concept, as if you are explaining it to your friend from home who has never studied these concepts. DON’T COPY the definition from the textbook, as the point is for you to show (in your own words) what you understand.  

Concept Application [900-1000 Words]

For each of the five concepts you choose from the semester, you should:

Explain a bit about the concept, then explain how and/or why you would use that concept in your leadership development or in your organization, depending upon the concept. Use the results from your assessments over the semester to describe your application. 

Repeat the process for other concepts that we have studied throughout the course so that you have identified a total of five valuable concepts that you wish to remember and use. Do not repeat the use of assessment/concepts you have already discussed in your leadership assessment papers, except to compare/contrast or validate past results.  You can choose any concepts from the entire semester for this assignment.

Conclusion [150-200 Words]

Make sure to write a conclusion that summarizes the value of these lessons as you project yourself into a future leadership role.  

MAKE SURE TO REVIEW THE RUBRIC BELOW AND ALLOCATE THE CONTENT YOU WRITE ACCORDINGLY.

Format

The paper should be 1,450 – 1,650 words. Being concise is a skill you can always work on to improve. Please make sure to use appropriate writing mechanics and take care to edit your papers to be sure that the sentence structure and spelling are correct and effective. You should not have a reason to use citations or references, because I am asking you to NOT “copy and paste” ideas from the textbook, so you should be able to explain these ideas in your own words.

• 12-point Arial type
• One-inch margins all the way around
• Double spaced
• Use of headers to guide reader through the paper
• No title page or citations are needed as the concepts are from the text and you are applying them to your personal vision
• You name must be at the top of the first page
• Assignment title and file name should be “VisionPaper_ Last Name”
• Submitted through Moodle as a WORD file
• All papers will be checked for originality using TII.

 

Option #2: PetroCo Refinery Case Study

Go to pp. 111-112 in Leadership Communication and read the Case Study on PetroCo Refinery. Do the assignment on page 112:

Draft an email to the site services managers scheduling a meeting to discuss the budget (alternatively, you may choose to create a meeting request). Since you have no direct supervisory control, it will do little good to demand cuts; in fact, a demand to cut budget might result in the loss of a service that matters most to you! Therefore, consider your strategy and your persuasive approach carefully as you prepare the email. You may also consider whether to use a direct or indirect approach to the memo. Remember to craft a clear and complete subject line for the memo, provide all the information they need to attend the meeting, and close with the next steps or how to contact you for further information. In addition, consider what you might want to send to your audience to help prepare them for the meeting. Include a list of the attachments you would include with this email along with a brief explanation of why you would include them.

Refer to this week’s readings for more information on the four steps. Your email and supporting documents should conform to CSU Global Writing Center (Links to an external site.), and include appropriate references. The CSU Global library is a great place to locate these resources. Refer to the rubric for grading details.